(P025) EQUITY CONSIDERATIONS IN EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION FOR ADULTS WITH REFRACTORY CARDIAC ARREST

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a recognized treatment option for refractory cardiac arrest (CA) in adults, endorsed by the American Heart Association (AHA), European guidelines, and the Extracorporeal Life Support Organization (ELSO). However, factors that influence the efficacy of eCPR such as, specialization of the medical teams and resources and the witnessed occurrence of CA, raise concerns about resuscitation health equity. The aim of this study is to formally review eCPR randomized controlled trials (RCTs) to understand their implications on equity and inform guideline recommendations.

METHODS AND RESULTS: We searched the International Liaison Committee on Resuscitation (ILCOR) website for the latest scientific summaries on Advanced Cardiovascular Life Support (ACLS) to identify the comprehensive evidence on eCPR use. The RCTs were reviewed using a validated seven-step approach described in table 1. Populations experiencing inequities were deliberated by resuscitation experts in table 2. We identified Four RCTs of which two were conducted in the USA, one in Czech Republic and one in Netherlands. A total of 435 patients were included across the RCTs. All the RCTs were conducted in urban areas with well-equipped hospitals. All the RCTs excluded older adults (aged 60 to 75 years). Ventricular Fibrillation cardiac rhythm in the control arms of the RCTs ranged from 64% to 100%. All RCTs described the assumed sex and age of the participants but only two RCTs described assumed race or ethnicity. Women and Black individuals were notably underrepresented in the RCTs, with a Participant-Prevalence Ratio (Interquartile range) of 0.47 (0.42 to 0.58) and 0.26 (0.26 to 0.26), respectively. All the RCTs planned to conduct exploratory analyses across sex and ethnicity but only one RCT was able to conduct the analysis across sex for survival with minimal or no neurologic impairment at 180 days. The subgroup analysis, which was deemed to have low credibility and underpowered, revealed no significant difference across sex (interaction term p = 0.46).

Conclusion: The findings of the RCTs raise questions about the generalizability of the results to low resource hospitals and non-urban settings. Underrepresentation of women and racialized populations may be due to restricting participant eligibility to those who had bystander CPR or witnessed cardiac arrest. These aspects must be considered when assessing the strength of the recommendation upon updating the recommendations. Future RCTS should collect and report other patient demographic characteristics to inform applicability of findings to other populations and plan hypothesis-driven subgroup analyses.